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General NPI Number Information
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NPI Number | 1659181469
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Entity Type | Individual
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Provider Name | BROOKE PETKOVICH
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Gender | Female
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Dates
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Enumeration Date | 01/13/2025
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 8501 WILSHIRE BLVD STE 336
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-3134
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Country | US
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Telephone | 424-239-7817
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Fax |
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Provider Business Mailing Address
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Address Line | 5608 ERLANGER RD
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City | KENNER
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State | LA
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Zip | 70065-1564
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Country | US
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Telephone | 504-615-2133
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 11483
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 307551
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License Number State | CA
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